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Emergency Medicine, Ethics, Global Health, Medicine and Society, Patient Care

After Haiyan: Stanford med student makes film about post-typhoon Philippines

After Haiyan: Stanford med student makes film about post-typhoon Philippines

Multi-talented Stanford Medicine student Michael Nedelman has been featured on Scope before for his filmmaking and storytelling abilities. His new film, “After Haiyan: Health narratives in the aftermath of the typhoon,” is a series of vignettes about the November 2013 disaster in the Philippines. The film, which will be released soon, connects socioeconomic and structural issues of access to health in times of crisis.

It was filmed primarily in Tacloban, Leyte, in July and August of 2014, and Nedelman made a follow-up visit in November and December to premiere and promote the project. Despite his busy end-of-school-year schedule, Nedelman answered some questions for me about his work in a recent email exchange.

What was it like filming in the wake of a tragedy? 

Phil Delrosario said it best. He’s the cinematographer and editor I met here at Stanford. Knowing when to turn on the camera was a “huge balancing act” between our drive to document the truth, and our obligation to be compassionate storytellers. We couldn’t ignore the emotional weight of Typhoon Haiyan, and we couldn’t ignore the fact that we weren’t part of the communities we were documenting. So we sought out people who not only wanted to share their stories with us, but who could also provide some insight as to how they wanted those stories to be seen… For one of the videos, Deaf advocates like Noemi Pamintuan-Jara reached out to us first, not the other way around… That was really special for us, to be able to work alongside a community that has been promoting Deaf accessibility and culture long before we ever arrived on the scene. And we had these new partners who could give meaningful feedback on our filmmaking decisions.

Filming in the wake of a tragedy doesn’t mean everything is tragic. The shadow of Haiyan is still there, but there’s also a sense of living in the moment and moving forward. All over the city, you’ll see posters and graffiti that say, “Tindog Tacloban!” (“Rise Tacloban!”) That’s something that really resonated with our team and the ethos of our project. You can’t tell the full story of Tacloban without optimism and resilience.

How does this film link storytelling and health, and what is special about that for you?

When I was first discussing the project with one of the producers, Roxanne Paredes, we asked ourselves a similar question: How would our project add to or nuance the coverage of the typhoon? Right after the storm, Haiyan was all over the news. Tacloban was in survival mode. But months later, after many of those cameras had left, there was a different set of long-term challenges and a focus on recovery. Those were the issues we wanted to explore, which tend to be less covered by the media but still have profound implications for community health and future disaster preparedness. In short, just because the cameras stopped rolling doesn’t mean there weren’t more stories to tell. That really broadened the way in which I think of health stories.

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Global Health, HIV/AIDS, Infectious Disease, Public Health, Research, Rural Health

Drought causes spike in HIV infections in Africa

Drought causes spike in HIV infections in Africa

75148497_50e081cd5b_zHere in California, the drought is plenty serious. Shortages mean short showers, brown lawns, empty reservoirs and fallow fields.

But in sub-Saharan Africa, drought spreads disease, including the still-rampant HIV virus. The phenomenon is more sociological than ecological: Slim harvests slash farmers’ incomes, forcing them to find new ways to earn money. Some turn to sex, according to a new study in The Economic Journal.

As described in a recent article from Stanford’s Center on Food Security and the Environment (FSE):

Analyzing data on more than 200,000 individuals across 19 African countries, the research team finds that by changing sexual behavior, a year of very low rainfall can increase local infection rates by more than 10 percent.

That means condoms and sex education aren’t all that’s needed to thwart the epidemic’s spread, the study’s authors say. Affected farmers also need economic support and alternatives to help them weather the dry period, without sacrificing their health.

“These are the people who really suffer when the rains fail, and who are forced to turn to more desperate measures to make ends meet,” co-author Marshall Burke, PhD, a fellow at the FSE, said in the piece.

Previously: Spread of drug-resistant HIV in Africa and Asia is limited, Stanford research finds, Stanford study: South Africa could save millions of lives through HIV prevention and Changing the prevailing attitude about AIDS, gender and reproductive health in southern Africa 
Photo by Jon Rawlinson

Bioengineering, Cardiovascular Medicine, Global Health, Stanford News, Technology

Stanford-India Biodesign co-founder: “You can become a millionaire, but also make a difference”

Stanford-India Biodesign co-founder: "You can become a millionaire, but also make a difference"

This post is part of the Biodesign’s Jugaad series following a group of Stanford Biodesign fellows from India. (Jugaad is a Hindi word that means an inexpensive, innovative solution.) The fellows will spend months immersed in the interdisciplinary environment of Stanford Bio-X, learning the Biodesign process of researching clinical needs and prototyping a medical device. The Biodesign program is now in its 14th year, and past fellows have successfully launched 36 companies focused on developing devices for unmet medical needs.

4499846308_9f084d26f0_zThe three Indian biodesign fellows who were at Stanford for the past six months have returned to New Delhi, where they’ll finish up their fellowship. They’re the last class of fellows from the Stanford-India Biodesign program, and in India they’ll be joining two teams already in progress as part of the new School of International Biodesign (SIB).

Balram Bhargava, MD, executive director of Stanford-India Biodesign (India), was at Stanford for the fellow’s final presentation of their prototype. He helped establish the relationship between Stanford and India and is now revamping the new self-sufficient program.

How did Stanford-India Biodesign originate?

I was at a retirement party in September 2006 for Ulrich Sigwart, MD, who developed the first stent. He called in some friends from all over the world, including Paul Yock, MD (director of the Stanford Biodesign Program). Paul and I shared a taxi ride to Ulrich’s vacation home and got talking. That’s when the program started. By January 2008 the first batch of fellows was here.

The basic intent was to start this innovative program in India and ultimately make it self-sufficient. We selected students from India and sent them to Stanford, then they finished out their fellowship in India.

How has the program changed over the years?

Our early fellows returned from Stanford with high-end ideas such as robots. I had to pull them all down back to the ground. My role was to give this program a soul, and I think I have been successful at that. After a few years Stanford also accepted that frugal design was the right thing for the world and I’m happy about that.

Many of our students had the intention of setting up a company and becoming millionaires. We’ve given them the idea that you can become a millionaire, but at the same time you can make a difference. That’s the delicate balance we want to teach. The students have been very bright and many of them have really delivered on this dream.

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Behavioral Science, Global Health, In the News, Public Health, Research, Sleep, Technology

Electricity access shortens sleep, study shows

Electricity access shortens sleep, study shows

Radium_Dial_UVGrowing up, my engineer father always told me to move my flowery glow-in-the-dark clock farther from my bedside. “You’re nuts, Dad,” I would respond, equating his concern with his conviction that he was dropped off by aliens in the New Mexican desert in 1947.

But now it turns out he may have had a point (although I’m still quite sure he came from a hospital in Pennsylvania, not a spaceship).

A new study published in the Journal of Biological Rhythms has shown that access to artificial light at night has shortened the amount of time we sleep each night. A recent University of Washington release describes the study:

The researchers compared two traditionally hunter-gatherer communities (in Argentina) that have almost identical ethnic and sociocultural backgrounds, but differ in one key aspect – access to electricity…

In their usual daily routines, the community with electricity slept about an hour less than their counterparts with no electricity. These shorter nights were mostly due to people who had the option to turn on lights and go to bed later, the researchers found. Both communities slept longer in the winter and for fewer hours in the summer.

This is the first study to examine differences in communities, rather than relying on artifically manipulating light in a laboratory.

“In a way, this study presents a proxy of what happened to humanity as we moved from hunting and gathering to agriculture and eventually to our industrialized society,” said lead author Horacio de la Iglesia, a University of Washington biology professor. “All the effects we found are probably an underestimation of what we would see in highly industrialized societies where our access to electricity has tremendously disrupted our sleep.”

So douse those lights, turn off the TV, push back your glowing clock, and embrace the dark — with a nice, long snooze.

Previously: New recommendation: Adults need at least 7 hours of sleep each nightMobile devices at bedtime? Sleep experts weigh in and Can adjusting your mobile device’s brightness help promote better sleep?
Via Medical News Today
Photo by Arma95

Global Health, Health Disparities, Health Policy, Stanford News

Rosenkranz Prize winners devoted to innovative health care in developing countries

Rosenkranz Prize winners devoted to innovative health care in developing countries

African girls studyingMarcella Alsan, MD, PhD, knows that the division of labor among men and women starts at a young age in the developing world.

“Anecdotally, girls must sacrifice their education to help out with domestic tasks, including taking care of children, a job that becomes more onerous if their younger siblings are ill,” Alsan, a core faculty member at the Center for Health Policy/Center for Primary Care and Outcomes Research (CHP/PCOR) within the Freeman Spogli Institute of International Studies, recently told me.

More than 100 million girls worldwide fail to complete secondary school, despite research that shows a mother’s literacy is the most robust predictor of child survival. So Alsan is analyzing whether medical interventions in children under 5 tend to lead their older sisters back to school. She’ll compile data from more than 100 Demographic and Health Surveys covering nearly 4 million children living in low- and middle-income countries. The surveys ask about episodes of diarrhea, pneumonia and fever in children under 5 and record data on literacy and school enrollment for every child in the household.

“My proposed work lays the foundation for a more comprehensive understanding of how illness in households and early child health interventions impact a critical determinant of human development: an older girl’s education,” Alsan, the only infectious-disease trained economist in the United States, said.

Alsan is one of two winners of this year’s Rosenkranz Prize for Health Care Research in Developing Countries, awarded by CHP/PCOR. Her Department of Medicine colleague, Jason Andrews, MD, is the other recipient of the $100,000 prize, which is given to young Stanford researchers to investigate ways to improve access to health care in developing countries.

In the current scientific climate, most National Institutes of Health grants go to established researchers. The Rosenkranz Prize aims to stimulate the work of Stanford’s bright young stars – researchers who have the desire to improve health care in the developing world, but lack the resources.

While Alsan is researching how older girls in poorer countries are impacted by the health of their younger siblings, Andrews is focusing his attention on cheap, effective diagnostic tools for infectious diseases.

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Global Health, Health Policy, Medicine and Society, Public Health, Stanford News

The battle against big tobacco hits the classroom

The battle against big tobacco hits the classroom

4822770407_f1a230b06c_bIn Malawi, children as young as five years old work in tobacco fields. Here, in the Silicon Valley, five-year-olds compete to attend top preschools. Stanford communications major Minkee Sohn highlighted that dramatic contrast with a parody video, “Fresh Recruits,” for a new Stanford anthropology class. Taught by Matthew Kohrman, PhD, the class, “Smoke and Mirrors in Global Health,” aimed to raise awareness about the global tobacco industry and was the subject of a recent Stanford News article.

Simply acknowledging that “smoking is bad for you” is no longer enough to halt tobacco’s spread. As noted in the piece, the tobacco industry remains a powerful global force and produces three times as many cigarettes as it did during the smoking heyday in America in the 1960s; it’s also the source of millions of preventable deaths. Kohrman encouraged his students to develop original communication strategies and to take on hard-hitting issues, such as the use of underage labor.

For their final projects, Kohrman’s class presented a slew of web-based videos, exposés and written critiques exploring little known facets of the global tobacco industry, including:

  • Chinese academia’s involvement in the tobacco industry
  • Philip Morris’ use of child labor in Africa
  • South Korea’s flawed approaches to tobacco control

Overall, Kohrman, an associate professor of anthropology, deemed his experimental class a “great success.” The course uncovered many little-known aspects of global tobacco, and taught students to “understand the sociocultural means by which something highly dangerous to health such as the cigarette is made both politically contentious and inert.”

Alex Giacomini is an English literature major at UC Berkeley and a writing and social media intern in the medical school’s Office of Communication and Public Affairs.  

Previously: A call to stop tobacco marketing, Cigarettes and chronographs: How tobacco industry marketing targeted racing enthusiasts and How e-cigarettes are sparking a new wave of tobacco marketing 
Photo by Jo Naylor

Global Health, Nutrition, Pediatrics, Stanford News, Technology, Women's Health

Stanford initiative aims to simultaneously improve education and maternal-child health in South Africa

Stanford initiative aims to simultaneously improve education and maternal-child health in South Africa

Nomfusi_counselingWhat if we could “leapfrog” over the education and technology gap in low-resource countries, while at the same time improving maternal and early childhood health in those areas? That is precisely the promise of a new Stanford-sponsored initiative spearheaded by Maya Adam, MD, a lecturer in the human biology program here.

I recently had the chance to speak on the phone with Adam and hear more about this project, which consists of designing picture-based educational videos that are loaded on tablets and distributed among community-health workers. At present, the video on child nutrition is being used as a pilot in South Africa through the organization Philani, where twelve “mentor mothers” have been using the tablets since March. As you’ll read below, there is immense potential for the project to scale up in the near future.

What have the results of this initiative been so far?

The feedback that we’ve gotten was that a lot of the mothers being counseled said, “You know, you’ve been using phrases like ‘balanced diet’ for many years, and I didn’t quite know what that meant until I saw the plate with the green vegetables and the little bit of protein and the little bit of grains.” Certain phrases became clearer when they were drawn in pictures. Also, we found a lot of the children wanted to come watch because it was a screen-based activity.

The workers themselves found it useful to convince their patients, for example, of the importance of prenatal care, because when the patients heard it both from the video and from them, it was almost as if the video was validating their messaging. So they’re very eager to have the project continue. They have a whole list of other videos they want us to make, from breastfeeding to HIV/AIDS prevention… It’s really been a powerful way both to teach and give these highly intelligent women access to technology that could enhance their education and help them overcome the barriers in their lives.

How easy would it be to use these videos in different regions of the world? 

slider-9_compressedWe have videos translated into English, Xhosa, and now Spanish, because they’ll be used next in Guatemala… We can use English in the U.S. in under-resourced locations. These are all very universal messages, and that’s why it’s so exciting: For a relatively small amount of effort, we can make videos that can be both translated into many other languages, and subtly altered visually so they resemble women and children in each different part of the world. For example, while we were creating the video, we put the braids that African women traditionally wear in their hair on a different layer of the Photoshop, so that layer can be removed and the resulting woman will have straight dark hair that would be more appropriate for use, say, in Guatemala.

We thought a lot about how to represent food. A real plate of food from South Africa would be culturally inappropriate in Guatemala, but by using cartoon images of fruits and vegetables, it becomes much more universal… We tried to show a variety of different fruits and vegetables without specifically showing that “this is a guava,” because a guava might not grow in other parts of the world.

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Cancer, Global Health, Medicine and Society, Patient Care, Stanford News

Educating cancer patients in Africa and beyond

Educating cancer patients in Africa and beyond

ph_grid7_20554_74781Imagine beginning chemotherapy without being aware of the side effects. You’re feeling sicker than you felt before the medication, experiencing nausea, muscle weakness and losing your hair. You wonder if this is normal, but you can’t interpret the drug safety information because you don’t know how to read. You’re tempted to stop taking the medication.

Realizing that many of their patients had grappled with this dilemma, cancer care providers at Queen Elizabeth Central Hospital in Blantyre, Malawi approached Global Oncology, a non-profit co-founded by Ami S. Bhatt, MD, PhD, for help.

With one oncologist and an overstretched clinical team, clinicians at Queen Elizabeth recognized they often don’t have time to explain the chemotherapy treatment process to each patient. And, many of these patients struggle to read and comprehend complex instructions and medical terminology.

So they decided to create clinically relevant and culturally appropriate education materials designed for a low literacy patient population.

Veronica Manzo, a first-year medical student at Stanford and a member of Bhatt’s lab, is part of a team of Global Oncology volunteers developing the educational materials. She began volunteering with GO while she was working at the Dana-Farber Cancer Institute and is working to establish a chapter of the GO Young Professional Alliance at Stanford. The group held its inaugural meeting on campus last month.

cancer pamphlet“The existing materials were often too high-level for low literacy patients – wordy, complex and not designed for that culture or audience,” Manzo told me. “We looked at the most common chemotherapies in Malawi and created materials designed to target the specific side effects associated with the treatment.”

Together with Cambridge-based design firm, THE MEME Design, Manzo and a team consulted with medical and health-literacy experts to simplify complex medical information – incorporating simple language and culturally relevant illustrations – and package it in a way that could be easily printed and distributed by partners in low resource settings. The final 8-page booklet, “Cancer and You,” was introduced at Queen Elizabeth last summer and has become a helpful tool that educates patients and caregivers and improves treatment adherence.

Since the project began in 2013, the team has also collaborated with Partners in Health to modify and implement the materials in Rwanda and Haiti, and they hope to expand the work to Guatemala, India and additional sites in Africa and South America. To help support this expansion, Global Oncology has launched a 30-day fundraising campaign through Global Giving with the aim to raise $5,000 from 40 donors by the end of June.

“It’s exciting to see the positive impact the patient education materials have had in Malawi and Rwanda, and we’re looking forward to expanding this initiative to help close the gaps in patient cancer education worldwide,” said Bhatt, director of global oncology at the Center for Innovation in Global Health.

Rachel Leslie is the communications officer at Stanford’s Center for Innovation in Global Health.

Previously: Oncology hashtag project aims to improve accuracy of online communication about cancer, Stanford fellow addresses burden of cervical cancer in Mongolia and Providing medical, education and technological tools in Zimbabwe
Images by Global Oncology and THE MEME Design

Bioengineering, Global Health, Stanford News, Technology

Success breeds success: Early innovators in India created a sense of possibility

Success breeds success: Early innovators in India created a sense of possibility

This post is part of the Biodesign’s Jugaad series following a group of Stanford Biodesign fellows from India. (Jugaad is a Hindi word that means an inexpensive, innovative solution.) The fellows will spend months immersed in the interdisciplinary environment of Stanford Bio-X, learning the Biodesign process of researching clinical needs and prototyping a medical device. The Biodesign program is now in its 14th year, and past fellows have successfully launched 36 companies focused on developing devices for unmet medical needs.

MATERNAL & INFANT MORTALITY IN DEVELOPING COUNTRIESAnurag Mairal, PhD, MBA, director of global exchange programs, joined Stanford-India Biodesign in 2008 to help fellows navigate challenges in designing new medical technology in India, which at the time had great need but little infrastructure for developing and marketing new technologies. I recently spoke with him about the program.

What were the challenges for Biodesign in India when you started?

When I joined Stanford-India Biodesign I felt it was going to be a difficult ride knowing India at that time. The mindset in India is very traditional and doesn’t allow people to step out of the box. Here in the United States what is remarkable is that we have everything across the street. Design, prototypes, animal labs, testing facilities, venture capital — they are all easily accessible. In India none of that existed. We needed to build all of that because it was going to be important to the success of Biodesign.

I had experience in emerging markets and was able to step in when the fellows needed to start thinking about markets for their products. I had a good understanding of the needs and also what challenges a typical medical device would face.

Have things changed?

One of the remarkable things that happened is that not only was the program successful, it affected other institutions in India in both the private sector and academia. A lot of innovators are now working on new technologies across India. Now we need to help all of them with commercializing the technology.

Success breeds success. When one group has success developing a medical technology it makes other people believe it is possible. That sense of possibility and reality has been a major accomplishment. The success of the early fellows and the ecosystem we built around them brought people together and energized the following batches of innovators. Now there is no doubt that medical device innovation is a real thing in India. It’s a remarkable shift in tone in that marketplace.

What is next for Stanford-India Biodesign now that fellows won’t be spending extensive time at Stanford?

Phase 1 of Stanford-India Biodesign was training fellows in the Biodesign process. Most of those previous fellows are in development mode now, and we see challenges in commercializing their products. I think there is a lot of work that needs to happen before these technologies are successful in the marketplace in India. Phase 2 will focus on training entrepreneurs and innovators on the entire process of developing and commercializing a product.

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Bioengineering, Global Health, Medicine and Society, Research, Stanford News, Technology

National Geographic: “Emerging Explorer” Manu Prakash helping “lead a new age of discovery”

National Geographic: "Emerging Explorer" Manu Prakash helping "lead a new age of discovery"

Prakash in Nigeria - 560

As I’ve gotten busier, and my life has moved online, I’ve let most of my magazine subscriptions lapse. All except for National Geographic, which both my husband and I continue to enjoy each month.

With its storied history, familiar yellow cover, knock-your-socks-off photography and carefully crafted science and social science features, I consider it a good use of precious paper (and pennies).

So I was psyched to hear that Stanford’s own Manu Prakash, PhD, has been named by the publication as one of 14 2015 National Geographic Emerging Explorers. Prakash is most well-known for the Foldscope, a low-cost paper microscope that has been sent to 130 countries, but he’s also working on constructing a small-scale chemistry kit and on a variety of other projects. As summarized in a National Geographic article, he “specializes in what he calls ‘frugal science,’ designing inexpensive laboratory instruments that can spread science and medical opportunity around the world.”

Thanks to the Explorers program, he’ll gain $10,000 to support his research and a year in the international spotlight. As indicated in the article, expectations of him and the other winners are high:

“Our Emerging Explorers are inspiring young visionaries who are looking at ways to remedy global problems and are undertaking innovative research and exploration,” said Terry Garcia, National Geographic’s chief science and exploration office. “They will help lead a new age of discovery.”

Here’s to looking forward to year of innovative “frugal sciences” creations from the Prakash lab.

Previously: Microscopes for the masses: How a Stanford bioengineer is helping everyone “think like scientists”, Miniature chemistry kit brings science out of the lab and into the classroom or field, Stanford bioengineer among Popular Science magazine’s “Brilliant 10″Manu Prakash on how growing up in India influenced his interests as a Maker and entrepreneur and Stanford bioengineer develops a 50-cent paper microscope
Photo, of Manu Prakash and a group of children in Nigeria, courtesy of Prakash

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